Comparison of Emergency Department Wait Times in Adults with Sickle Cell Disease Versus Other Painful Etiologies

Abstract

Sickle cell disease is characterized by intermittent painful crises often requiring treatment in the emergency department (ED). Past examinations of time-to-provider (TTP) in the ED for patients with sickle cell disease demonstrated that these patients may have longer TTP than other patients. Here, we examine TTP for patients presenting for emergency care at a single institution, comparing patients with sickle cell disease to both the general population and to those with other painful conditions, with examination of both institutional and patient factors that might affect wait times. Our data demonstrated that at our institution patients with sickle cell disease have a slightly longer average TTP compared to the general ED population (+16 min.) and to patients with other painful conditions (+4 min.) However, when confounding factors were considered, there was no longer a significant difference between TTP of patients with sickle cell disease and the general population nor between patients with sickle cell disease and those with other painful conditions. Multivariate analyses demonstrated that gender, race, age, high utilizer status, fast track use, time of presentation, acuity and insurance type, were all independently associated with TTP, with acuity, time of presentation and use of fast track having the greatest influence. We concluded that the longer TTP observed in patients with sickle cell disease can at least partially be explained by institutional factors such as the use of fast track protocols. Further work to reduce TTP for sickle cell disease and other patients is needed to optimize care.

Keywords:

• Disparity
• sickle cell disease
• wait times

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article. D.P. declares the following potential conflicts of interest: clinical trial funding from Selexys Pharmaceuticals (Oklahoma City, OK, USA) and ApoPharma (Toronto, ON, Canada). Neither organization provided funding for the study described in this manuscript.

D.P. and P.L. designed the study and performed the initial analyses; A.C., J.Mc.A. and R.P. performed the definitive analyses. All authors contributed to the interpretation of the data; D.P. wrote the manuscript. All authors critically reviewed and approved the final manuscript.